Chulalongkorn Medical Journal


Background: Streptococcus pneumoniae is a common causative organism of pneumonia, bacteremia and meningitis in children. Rate of drug-resistant Streptococcus pneumoniae (DRSP) is an important information to guide appropriate empirical antibiotics. Objectives: This study aimed to describe rates of DRSP and clinical outcomes of patients with invasive pneumococcal disease (IPD). Methods: A retrospective study was conducted among pediatric patients with IPD from 2008 -2017. DRSP was defined as National Committee for clinical laboratory standards guidelines 2013. Results: From January 2008 to December 2017, 71 patients with diagnosis of IPD were identified. Median (interquartile range) age was 2 years (2 months - 15 years 2 months). Forty-seven patients (66.0%) had underlying diseases, the most was congenital heart diseases (15.0%). There were 25 patients with bacteremia with or without localized infection and 46 patients with pneumonia. Proportion of penicillin-resistant S. pneumoniae (PRSP) infection increased from 17.5% (95% CI 7.4 - 32.8) during 2008 - 2012 to 25.8% (95% CI 11.9 - 44.6) during 2013 - 2017 (P - value = 0.39). Third generation cephalosporins-resistant S. pneumoniae infection was stable during the two time periods, which was 5.0% (95% CI 1.0 - 16.9) during 2008 - 2012 and 3.2% (95% CI 0.1 - 16.7) during 2013 - 2017 (P - value = 0.71). The common empirical antibiotics treatment included third generation cephalosporins (79.0%), meropenem (8.0%), third generation cephalosporins plus vancomycin (4.0%) and others (9.0%). Only one patient died from bacteremia with sepsis directly related to IPD. Conclusion: There is an increasing trend of PRSP over the past decade but not to the extent of third generation cephalosporins-resistant. Therefore, third generation cephalosporins stand as a good option for IPD empirical treatment.



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